WASHINGTON – Bitter infighting among President Donald Trump’s top health officials – which reached a fever pitch this week – is undermining the administration’s efforts to take major regulatory action on lowering drug prices and other health-care issues.
White House officials are frantically trying to resolve the fractured relationship between Health and Human Services Secretary Alex Azar and Seema Verma, head of the agency’s Centers for Medicare and Medicaid Services. But it’s not clear they’ll succeed.
Vice President Mike Pence convened a five-way meeting Wednesday afternoon aimed at reconciling the two’s bitter differences. Acting White House chief of staff Mick Mulvaney and Pence’s chief of staff Marc Short were also present at the meeting, where the officials told Verma and Azar that Trump likes both of them but that they need to start getting along.
Verma and Azar’s feuding has recently become public, alongside multiple damaging leaks about Verma’s use of contractors to boost her profile at a cost of nearly $3 million to taxpayers and an attempt to recoup $47,000 from the government for jewelry and clothing stolen on a work trip, stories that were first reported by Politico.
Verma once enjoyed a positive relationship with the White House for publicly attacking Medicare-for-all and championing Medicaid work requirements. But the reports of misusing taxpayer money have damaged Verma’s reputation,
Some congressional Democrats are starting to call on Verma to resign.
Aides said Thursday’s meeting was a last-ditch effort to keep Verma and Azar both in the administration and persuade them to work together. But their interpersonal drama – along with tricky legal and policy questions – has already complicated Trump’s quest to lower steep drug prices in the United States.
The president has delivered little on that goal, despite rolling out a policy blueprint 19 months ago. Two drug pricing proposals he has championed – allowing the importation of certain cheaper drugs from Canada and basing the price of some Medicare drugs on the lower prices paid by several other countries – have been stalled by internal disputes, as well as technical and regulatory issues.
“The chaos and conflict continue to thwart Trump’s agenda by consuming significant time and dividing White House and senior administration officials into camps,” Yasmeen writes.
The two camps look something like this, according to our story. Verma’s supporters include Ivanka Trump, Domestic Policy Council head Joe Grogan and Marc Short, the vice president’s chief of staff, while White House Counsel Pat Cipollone and first lady Melania Trump tend to take Azar’s side.
For a prime example of how the alliances have hindered policymaking, consider the administration’s now-abandoned effort to end the rebates drugmakers give pharmacy middlemen. As Azar worked earlier this year on the proposal, Grogan and Verma collaborated to undercut his efforts. Verma and Grogan argued in an Oval Office meeting with Trump that its nearly $200 billion price tag over 10 years was exorbitant and would raise Medicare premiums just before the election.
The administration ultimately backed down from the effort, even though it was Azar’s pet project. Verma and Azar’s relationship deteriorated after the meeting, people close to them said.
The two haven’t gotten along for years, including when they both worked in Indiana. But officials say the tension among them and other players at the White House and HHS has grown untenable in recent months.
“This isn’t a band of brothers. It’s each man on his own. It’s a group of mercenaries,” a senior administration official told my colleagues, adding that senior officials pursue differing and even conflicting policies to fulfill the president’s requests.
One individual familiar with events told us that Verma is the victim of a “smear campaign” of “strategic leaks coming from inside HHS.” Verma has also relayed to the HHS general counsel several instances of perceived sex discrimination relayed to her by female employees of HHS and CMS, with the suggestion that HHS conduct sensitively training, that individual said.
Yet others who have worked with Verma say she’s not a team player and that she worked in the past to undermine Trump’s first HHS secretary, Tom Price.
“This is warfare between Alex and Seema,” said a source familiar with the drama. “What Pence should say to Seema is ‘cease and desist.’ ”
And then there’s a slew of other obstacles to Trump’s drug pricing agenda, including the president’s own changing moods and interests and the administration’s difficulty in identifying clear goals for Congress and helping get them passed. It remains unclear whether lawmakers will manage to pass bipartisan legislation tackling drug prices or surprise medical bills, not to mention Republicans’ well-documented failure to repeal and replace Obamacare back in 2017 despite Trump’s insistence that the law would be ditched.
Yet the president still has his defenders. Some current and former administration officials say Trump has changed the conversation around drug pricing by forcing Republicans to talk about an issue they traditionally ceded to Democrats, and by pressuring pharmaceutical companies to lower some prices, if only temporarily, after shaming some of them on Twitter.
“I’m very proud of the Trump administration’s record on health policy,” said Brian Blase, former special assistant to the president for health-care policy, told me. “It’s hard to change things administratively and we were able to accomplish a great deal, I think, as well as lay out a vision of where the Republican Party should be on health care.”